Transforming Our Systems, Transforming Ourselves Initiative Training Application
Please answer the following questions to complete your application
*Large organizations, that have an HIV/AIDS division of 20 or more people are eligible for this initiative as well. Please check the following box to indicate whether you are applying as an organization or division. *
Required
Name of Organization *
Primary Contacts *
Phone Number *
Email Address *
Organization Website *
Address *
Dates your organization is available for one day training *
(include tentative dates)
Demographics of Organization (Race) *
(Please include breakdown percentage of the race of individuals with your organization. For example: 10% African American, 10% White etc.)
Demographics of Organization (Gender Identity) *
(Include breakdown percentage of the gender identity of individuals within your organization. For example, 10% Women, 10% Gender Non Conforming etc.)
Number of Staff *
Demographics of Service Population (Race) *
(Include breakdown percentage of the race of individuals served by your organization. For example, 10% African American, 10% White etc.)
Demographics of Service Population (Gender Identity) *
(Include breakdown percentage of the gender identity of individuals served by your organization. For example, 10% Women, 10% Gender Non Conforming etc.)
Demographics of Service Population (Sexual Orientation) *
(include breakdown percentage of the sexual orientation of individuals served by your organization. For example, 10% gay, 10% trans, etc.)
Demographics of Service Population (Age) *
(Include breakdown percentage of the age of individuals served by your organization. For example, 10% children, 30% adults, etc)
Organizational Budget *
Is your organization willing to close the office for a full day training? *
Does your organization have regular discussions and trainings among staff and executive leadership about removing barriers to care and reducing health disparities? *
Does your organization have a mechanism in place to address complaints about structural barriers and inequities in the workplace? *
Is the commitment to addressing structural health barriers and disparities explicitly stated in your organization’s mission/vision statement? *
Does your organization have a plan to increase diversity and to promote staff of color at all levels? *
How do you see racism, transphobia, sexism or homophobia impact your organization and the people it serves (internally and externally)? *
Have there been any recent incidents in your organization that reflect racism, transphobia, sexism or homophobia? Please explain. *
Please describe to us in 250 words or less how your organization can benefit from the Unconscious Bias & Emotional Justice training, and how it plans to collectively commit to the Initiative’s objectives. *
Please upload a letter of commitment from your Executive Director or Executive Level staff stating the organization's investment in the Transforming Our Systems, Transforming Ourselves Initiative, with the understanding that it includes one full day of training for all staff, webinars, and 1 one 1 coaching, all free of charge. *
(please submit letter with official company letterhead)
Required
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